Anderson Charlotte, Abubakar Ibrahim, Maguire Helen, Sonnenberg Pam
Respiratory Diseases Department, Centre for Infections, Health Protection Agency, Colindale, NW9 5EQ, UK.
J Public Health (Oxf). 2007 Sep;29(3):292-7. doi: 10.1093/pubmed/fdm042. Epub 2007 Jun 28.
Tuberculosis (TB) incidence has increased in England and Wales since 1987, with much of the increase in migrants from high TB incidence countries. The National Health Service increasingly depends on healthcare workers (HCWs) trained abroad, often from areas of high TB incidence. A retrospective survey of TB incidents in hospital-based HCWs was carried out to describe their frequency, distribution and characteristics.
Reports of HCWs with TB in hospitals were identified among routine surveillance of TB incidents. Additional data on these and reports of further incidents fitting the study definition were obtained by contacting local and regional Health Protection Units.
At least 105 incidents of TB in hospital-based HCWs occurred in England and Wales in 2005. Most involved HCWs from high incidence countries, and most cases had pre-employment occupational health screening. We found no evidence of onward transmission within hospitals.
Pre-employment screening for active disease may not be enough to prevent the occurrence of these incidents. A high index of suspicion among HCWs with TB symptoms is needed. Detection of latent infection with interferon gamma release assays, and the use of preventive treatment, should be evaluated.
自1987年以来，英格兰和威尔士的结核病发病率有所上升，其中很大一部分增长来自结核病高发病率国家的移民。国家医疗服务体系越来越依赖在国外接受培训的医护人员，这些人员通常来自结核病高发病率地区。我们对医院医护人员中的结核病事件进行了回顾性调查，以描述其发生频率、分布情况和特征。
在结核病事件的常规监测中，识别出医院中患有结核病的医护人员报告。通过联系地方和区域卫生防护部门，获取了这些报告的其他数据以及符合研究定义的更多事件报告。
2005年，英格兰和威尔士至少发生了105起医院医护人员结核病事件。大多数事件涉及来自高发病率国家的医护人员，并且大多数病例在入职前进行了职业健康筛查。我们没有发现医院内进一步传播的证据。
对活动性疾病进行入职前筛查可能不足以预防这些事件的发生。对有结核病症状的医护人员需要保持高度怀疑。应评估使用干扰素γ释放试验检测潜伏感染以及使用预防性治疗的情况。
